Nevin Manimala

Clin Exp Hypertens. 2022 Mar 22:1-6. doi: 10.1080/10641963.2022.2055765. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effects of sacubitril/valsartan (S/V) on cardiopulmonary function and blood pressure response to exercise during hospitalization in patients with acute myocardial infarction (AMI) based on the cardiopulmonary exercise test (CPET).

METHODS: A total of 265 AMI patients were treated with either perindopril or S/V within 24 hours of admission. CPET was completed for all patients before discharge. There were 182 cases in the perindopril group and 83 cases in the S/V group.

RESULTS: The proportion of exercise oscillatory ventilation (EOV) was higher in the S/V group than in the perindopril group (10.8% vs 1.6%, X²= 11.148, P = .001). The resting heart rate (HR), resting diastolic blood pressure (DBP), and warm-up DBP were lower in the S/V group than in the perindopril group (P < .05). The resting systolic blood pressure (SBP) was 9.0 mmHg lower (115.7 ± 17.5 vs 106.7 ± 15.0, P < .001), the SBP during warm-up was 9.5 mmHg lower (124.8 ± 23.7 vs 115.3 ± 22.5,P = .002), the SBP at the anaerobic threshold (AT) was 10.5 mmHg lower (135.3 ± 24.8 vs 127.1 ± 25.1,P = .021),the SBP at max watts was 11.5 mmHg lower (148.9 ± 26.4 vs 137.4 ± 26.4,P = .001), and the SBP during one-minute recovery was 12.3 mmHg lower (146.5 ± 27.1 vs 134.2 ± 24.4, P = .001)in the S/V group than in the perindopril group. The S/V group had a higher oxygen ventilation equivalent and carbon dioxide ventilation equivalent (VE/VCO₂) at AT and a lower oxygen uptake-work rate relationship during max watts (P < .05). The differences in the oxygen pulse, stroke volume, peak oxygen uptake (VO_{2 peak}), and VE/VCO₂ slope were not statistically significant between the two groups.

CONCLUSION: Treatment with S/V was able to reduce the exercise blood pressure in patients with AMI during hospitalization, but did not significantly improve the VO_{2 peak}, VE/VCO₂ slope, or exercise tolerance.

PMID:35315303 | DOI:10.1080/10641963.2022.2055765

Am J Sports Med. 2022 Mar 22:3635465221083693. doi: 10.1177/03635465221083693. Online ahead of print.

ABSTRACT

BACKGROUND: Cartilage defects result in joint inflammation. The presence of proinflammatory factors has been described to negatively affect cartilage formation.

PURPOSE: To evaluate the effect and timing of administration of triamcinolone acetonide (TAA), an anti-inflammatory drug, on cartilage repair using a mouse model.

STUDY DESIGN: Controlled laboratory study.

METHODS: A full-thickness cartilage defect was created in the trochlear groove of 10-week-old male DBA/1 mice (N = 80). Mice received an intra-articular injection of TAA or saline on day 1 or 7 after induction of the defect. Mice were euthanized on days 10 and 28 for histological evaluation of cartilage defect repair, synovial inflammation, and synovial membrane thickness.

RESULTS: Mice injected with TAA had significantly less synovial inflammation at day 10 than saline-injected mice independent of the time of administration. At day 28, the levels of synovitis dropped toward healthy levels; nevertheless, the synovial membrane was thinner in TAA- than in saline-injected mice, reaching statistical significance in animals injected on day 1 (70.1 ± 31.9 µm vs 111.9 ± 30.9 µm, respectively; P = .01) but not in animals injected on day 7 (68.2 ± 21.86 µm vs 90.2 ± 21.29 µm, respectively; P = .26). A thinner synovial membrane was moderately associated with less filling of the defect after 10 and 28 days (r = 0.42, P = .02; r = 0.47, P = .01, respectively). Whereas 10 days after surgery there was no difference in the area of the defect filled and the cell density in the defect area between saline- and TAA-injected knees, filling of the defect at day 28 was lower in TAA- than in saline-injected knees for both injection time points (day 1 injection, P = .04; day 7 injection, P = .01). Moreover, there was less collagen type 2 staining in the filled defect area in TAA- than in saline-injected knees after 28 days, reaching statistical significance in day 1-injected knees (2.6% vs 18.5%, respectively; P = .01) but not in day 7-injected knees (7.4% vs 15.8%, respectively; P = .27).

CONCLUSION: Intra-articular injection of TAA reduced synovial inflammation but negatively affected cartilage repair. This implies that inhibition of inflammation may inhibit cartilage repair or that TAA has a direct negative effect on cartilage formation.

CLINICAL RELEVANCE: Our findings show that TAA can inhibit cartilage defect repair. Therefore, we suggest not using TAA to reduce inflammation in a cartilage repair setting.

PMID:35315287 | DOI:10.1177/03635465221083693

Swiss Med Wkly. 2022 Mar 18;152:w30137. doi: 10.4414/smw.2022.w30137. eCollection 2022 Mar 14.

ABSTRACT

AIMS OF THE STUDY: Clinical teaching is essential in preparing trainees for independent practice. To improve teaching quality, clinical teachers should be provided with meaningful and reliable feedback from trainees (bottom-up feedback) based on up-to-date educational concepts. For this purpose, we designed a web-based instrument, “Swiss System for Evaluation of Teaching Qualities” (SwissSETQ), building on a well-established tool (SETQsmart) and expanding it with current graduate medical education concepts. This study aimed to validate the new instrument in the field of anaesthesiology training.

METHODS: Based on SETQsmart, we developed an online instrument (primarily including 34 items) with generic items to be used in all clinical disciplines. We integrated the recent educational frameworks of CanMEDS 2015 (Canadian Medical Educational Directives for Specialists), and of entrustable professional activities (EPAs). Newly included themes were “Interprofessionalism”, “Patient centredness”, “Patient safety”, “Continuous professional development’, and “Entrustment decisions”. We ensured content validity by iterative discussion rounds between medical education specialists and clinical supervisors. Two think-aloud rounds with residents investigated the response process. Subsequently, the instrument was pilot-tested in the anaesthesia departments of four major teaching hospitals in Switzerland, involving 220 trainees and 120 faculty. We assessed the instrument’s internal structure (to determine the factorial composition) using exploratory factor analysis, internal statistical consistency (by Cronbach’s alpha as an estimate of reliability, regarding alpha >0.7 as acceptable, >0.8 as good, >0.9 as excellent), and inter-rater reliability (using generalisability theory in order to assess the minimum number of ratings necessary for a valid feedback to one single supervisor).

RESULTS: Based on 185 complete ratings for 101 faculty, exploratory factor analysis revealed four factors explaining 72.3% of the variance (individual instruction 33.8%, evaluation of trainee performance 20.9%, teaching professionalism 12.8%; entrustment decisions 4.7%). Cronbach’s alpha for the total score was 0.964. After factor analysis, we removed one item to arrive at 33 items for the final instrument. Generalisability studies yielded a minimum of five to six individual ratings to provide reliable feedback to one supervisor.

DISCUSSION: The SwissSETQ possesses high content validity and an “excellent” internal structure for integrating up-to-date graduate medical education concepts. Thereby, the tool allows reliable bottom-up feedback by trainees to support clinical teachers in improving their teaching. Transfer to disciplines other than anaesthesiology needs to be further explored.

PMID:35315268 | DOI:10.4414/smw.2022.w30137

J Public Health Res. 2022 Mar 22;11(2). doi: 10.4081/jphr.2022.2782.

ABSTRACT

BACKGROUND: Our aim is to evaluate the possible persistence of lung parenchyma alterations, in patients who have recovered from Covid-19.

DESIGN AND METHODS: We enrolled a cohort of 115 patients affected by Covid-19, who performed a chest CT scan in the Emergency Department and a chest CT 18 months after hospital discharge. We performed a comparison between chest CT scan 18 months after discharge and spirometric data of patients enrolled. We obtained quantitative scores related to well-aerated parenchyma, interstitial lung disease and parenchymal consolidation. A radiologist recorded the characteristics indicated by the Fleischner Society and “fibrotic like” changes, expressed through a CT severity score ranging from 0 (no involvement) to 25 (maximum involvement).

RESULTS: 115 patients (78 men, 37 women; mean age 60.15 years old ±12.52). On quantitative analysis, after 18 months, the volume of normal ventilated parenchyma was significantly increased (16.34 points on average ±14.54, p<0.0001). Ground-glass opacities and consolidation values tend to decrease (-9.80 and -6.67 points, p<0.0001). On semiquantitative analysis, pneumonia extension, reactive lymph nodes and crazy paving reached statistical significance (p<0.0001). The severity score decreased by 2.77 points on average (SD 4.96; p<0.0001). There were not statistically significant changes on “fibrotic-like” changes correlated with level of treatment and there was not a statistically significant correlation between CT lung score and spirometric results obtained 18 months after discharge.

CONCLUSIONS: Patients recovered from Covid-19 seem to have an improvement of ventilated parenchyma and “fibrotic-like” alterations. The level of treatment does not appear to influence fibrotic changes.

PMID:35315262 | DOI:10.4081/jphr.2022.2782

Biol Rev Camb Philos Soc. 2022 Mar 21. doi: 10.1111/brv.12851. Online ahead of print.

ABSTRACT

Subterranean ecosystems are among the most widespread environments on Earth, yet we still have poor knowledge of their biodiversity. To raise awareness of subterranean ecosystems, the essential services they provide, and their unique conservation challenges, 2021 and 2022 were designated International Years of Caves and Karst. As these ecosystems have traditionally been overlooked in global conservation agendas and multilateral agreements, a quantitative assessment of solution-based approaches to safeguard subterranean biota and associated habitats is timely. This assessment allows researchers and practitioners to understand the progress made and research needs in subterranean ecology and management. We conducted a systematic review of peer-reviewed and grey literature focused on subterranean ecosystems globally (terrestrial, freshwater, and saltwater systems), to quantify the available evidence-base for the effectiveness of conservation interventions. We selected 708 publications from the years 1964 to 2021 that discussed, recommended, or implemented 1,954 conservation interventions in subterranean ecosystems. We noted a steep increase in the number of studies from the 2000s while, surprisingly, the proportion of studies quantifying the impact of conservation interventions has steadily and significantly decreased in recent years. The effectiveness of 31% of conservation interventions has been tested statistically. We further highlight that 64% of the reported research occurred in the Palearctic and Nearctic biogeographic regions. Assessments of the effectiveness of conservation interventions were heavily biased towards indirect measures (monitoring and risk assessment), a limited sample of organisms (mostly arthropods and bats), and more accessible systems (terrestrial caves). Our results indicate that most conservation science in the field of subterranean biology does not apply a rigorous quantitative approach, resulting in sparse evidence for the effectiveness of interventions. This raises the important question of how to make conservation efforts more feasible to implement, cost-effective, and long-lasting. Although there is no single remedy, we propose a suite of potential solutions to focus our efforts better towards increasing statistical testing and stress the importance of standardising study reporting to facilitate meta-analytical exercises. We also provide a database summarising the available literature, which will help to build quantitative knowledge about interventions likely to yield the greatest impacts depending upon the subterranean species and habitats of interest. We view this as a starting point to shift away from the widespread tendency of recommending conservation interventions based on anecdotal and expert-based information rather than scientific evidence, without quantitatively testing their effectiveness.

PMID:35315207 | DOI:10.1111/brv.12851

J Prosthodont. 2022 Mar 21. doi: 10.1111/jopr.13507. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this in vitro study was to assess the efficacy of fiber reinforcement to enhance flexural strength of the transitional implant-supported fixed dental prosthesis (TISFDP).

MATERIALS AND METHODS: One hundred and forty denture acrylic resin plates (64×12×5mm) with two 7-mm in diameter holes were fabricated using heat-polymerized type (Lucitone 199) and CAD-CAM pre-polymerized type (AvaDent) materials to simulate a chair-side reconstruction of the TISFDP. Specimens were divided into 7 groups (n = 10) according to the airborne-particle abrasion of titanium cylinder (Straumann) surface and locations of fiber reinforcement ribbons (Ribbond-ULTRA). No cylinder surface abrasion and no fiber added acrylate specimens were used as the controls. The prosthetic screws were hand-tightened on a custom fixture with analogs. Specimen hole and cylinder were joined using a 50:50 mixture of chemically polymerized resin (QYK-SET; Holmes Dental) and repair resin (Dentsply Sirona). Ten acrylate specimens with no holes were fabricated from each tested material and assigned as positive controls. A modified four-point bending test (ASTM standard-D6272) was conducted by using a universal testing machine and a custom fixture with a crosshead speed 1 mm/min. The maximum failure loads were recorded. Data were statistically analyzed using 2-way ANOVA and the Tukey tests at α = 0.05.

RESULTS: The flexural strength values ranged from 55.4 ±8.3 MPa to 140.9 ±15.4 MPa. The flexural strength decreased significantly when fiber was attached on the titanium cylinder surface (p < 0.05). There were no statistically significant differences in flexural strength values between specimens with and without titanium cylinder surface abrasion (p > 0.05). Statistically significant improvement in flexural strength was observed in specimens with fibers attached around the specimen holes (p < 0.05) buccally and lingually. The obtained values were not statistically significantly different from the positive controls (p > 0.05). Some fixation screw fractures were observed before catastrophic failure of specimens during testing.

CONCLUSIONS: Fiber reinforcement significantly improved the flexural strength of denture acrylic resins only if placed around the specimen holes on the tension side at the site of initiation of crack propagation. Even when the specimens underwent catastrophic failure, the segments remained attached to each other with the attached fibers. This article is protected by copyright. All rights reserved.

PMID:35315177 | DOI:10.1111/jopr.13507

Eur J Cancer Care (Engl). 2022 Mar 21:e13577. doi: 10.1111/ecc.13577. Online ahead of print.

ABSTRACT

OBJECTIVE: To overview the colonoscopy adherence in cascade screening of colorectal cancer (CRC) and evaluate potential influence of the initial tests based on an ecological evaluation.

METHODS: The performance of the initial screening tests and adherence to subsequent colonoscopy were extracted from relevant studies published up to 16 October 2020. The age-standardised incidence (ASRi) of CRC in populations in the year of screening was derived from the Cancer Statistics.

RESULTS: One hundred sixty-six observational studies and 60 experimental studies were identified. Most studies applied cascade screening with faecal occult blood tests (FOBTs) as an initial test. The adherence to colonoscopy varied greatly across populations by continents, gross national income and type of initial tests, with a median (interquartile range) of 79.8% (63.1%-87.8%) in observational studies and 82.1% (66.7%-90.4%) in randomised trials. The adherence was positively correlated with the ASRi of CRC (r = 0.145, p = 0.023) and positive predictive value (PPV) of the initial tests (r = 0.206, p = 0.002) in observational studies and correlated with ASRi of CRC (r = 0.309, p = 0.002) and sensitivity of the initial tests (r = -0.704, p = 0.003) in experimental studies.

CONCLUSIONS: Adherence to colonoscopy varies greatly across populations and is related with performance of the initial tests, indicating the importance to select appropriate initial tests.

PMID:35315165 | DOI:10.1111/ecc.13577

Addiction. 2022 Mar 21. doi: 10.1111/add.15880. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: In previous research, the spatial distribution of alcohol outlets has been shown to be related to the spatial distribution of crime. However, the spatial distribution of alcohol outlets is also related to the spatial distribution of other retail (and non-retail) activities. We measured whether a residual relationship between alcohol outlets and crime remains statistically significant after controlling for retail density.

DESIGN AND SETTING: A cross-sectional analysis of area unit data for Hamilton, New Zealand.

MEASUREMENTS: We constructed index measures of retail density using principal component analysis, based on counts of retail outlets (non-alcohol outlets alone, and all outlets in total). We estimated the relationship between outlets and police calls-for-service using negative binomial regression, controlling for social deprivation, population and demographics. In our primary analysis, we employed a two-stage process that first accounted for the correlation between calls-for-service and retail density in a negative binomial regression model, then tested for correlation between alcohol outlet counts and the first-stage residuals.

FINDINGS: The spatial distributions of retail outlets of all types were highly correlated with each other, and all types of retail outlets (alcohol and non-alcohol) were correlated with crime, after controlling for social deprivation, population and demographics. After controlling for index measures of retail density and other controls, statistically significant semipartial correlations remained with counts of alcohol outlets of all types. For example, in our preferred specification, which controlled for non-alcohol retail density in the first stage, an additional off-licence alcohol outlet was associated with 97.34 (95% confidence interval [C.I.] 36.66-158.0) additional police calls-for service.

CONCLUSIONS: There is a positive relationship between the spatial distribution of alcohol outlets and the spatial distribution of crime that appears to persist even after controlling for non-alcohol retail density. The relationship between alcohol outlets and crime is not simply an artefact of retail geography.

PMID:35315160 | DOI:10.1111/add.15880

J Magn Reson Imaging. 2022 Mar 21. doi: 10.1002/jmri.28170. Online ahead of print.

ABSTRACT

BACKGROUND: Detecting and measuring intraluminal thrombus has prognostic and therapeutic implications for stroke patients.

PURPOSE: To investigate the feasibility of 3D isotropic high-resolution T1w-CUBE imaging to detect and measure intraluminal thrombus in stroke patients.

STUDY TYPE: Retrospective.

SUBJECTS: A total of 93 patients with acute (N = 39) and subacute (N = 54) stroke.

FIELD STRENGTH/SEQUENCE: A 3.0 T/spin-echo echo-planar diffusion-weighted imaging (DWI), high-resolution T1w-CUBE imaging and 3D flow compensated gradient-echo susceptibility-weighted imaging (SWI).

ASSESSMENT: Data assessment was performed by three neuroradiologists with 11, 13, and 20 years of clinical experience. The accuracy of T1W-CUBE and SWI in diagnosing thrombosis was compared by using digital subtraction angiography (DSA) as the reference. For thrombus length measurement, the image quality of proximal and distal thrombus of T1w-CUBE images was first evaluated with a 4-point rating system. Then, the proximal and distal positions to lesions were determined on T1w-CUBE images and compared with those from DSA acquired during endovascular reperfusion therapy. If comparable both locations were found between CUBE and DSA, CUBE imaging can thus be considered for accurate measurement of thrombus length.

STATISTICAL TESTS: Fleiss’ Kappa; the area under the receiver operating characteristic (ROC) curve (AUC); Pearson’s chi-squared test with Yates’ continuity correction.

RESULTS: Moderate-to-good interobserver agreements were validated with all Kappa coefficients higher than 0.40 in thrombus diagnosis and measurement. CUBE imaging showed higher clinical efficacy than SWI (AUC: 0.966 vs. 0.850) in thrombus diagnosis. Additionally, high quality of CUBE imaging was confirmed with 3 or 4 points rated by all three observers. Compared to intraoperative DSA, T1w CUBE showed consistent proximal and distal positions of thrombi in 16 of the 18 patients, validating the accuracy of T1w-CUBE in measuring thrombus length.

DATA CONCLUSION: T1w-CUBE imaging has potential to facilitate diagnosis and measurement of intraluminal thrombus.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:35315157 | DOI:10.1002/jmri.28170

Addiction. 2022 Mar 21. doi: 10.1111/add.15881. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: There are few longitudinal studies assessing the association of cannabis use and subsequent onset of bipolar disorder. We aimed to measure the association between early cannabis exposure and subsequent bipolar disorder.

DESIGN, SETTING, AND PARTICIPANTS: Observational study linking a sample from the Northern Finland Birth Cohort 1986 (n=6,325) to nationwide register data to examine the association of life-time cannabis exposure at age 15/16 years and subsequent bipolar disorder until age 33 (until the end of 2018). 6,325 individuals (48.8% males) were included in the analysis.

MEASUREMENTS: Cannabis exposure was measured via self-report. Bipolar disorder was measured via bipolar disorder-related diagnostic codes (ICD-10: F30.xx, F31.xx) collected from the Care Register for Health Care 2001-2018, the Register of Primary Health Care Visits 2011 – 2018, the medication reimbursement register of the Social Insurance Institution of Finland 2001 – 2005 and the disability pensions of the Finnish Center for Pensions 2001 – 2016. Potential confounders included demographic characteristics, parental psychiatric disorders, emotional and behavioral problems and other substance use.

FINDINGS: 352 adolescents (5.6 %) reported any cannabis use until the age of 15-16 years. Of the whole sample, 66 (1.0 %) were diagnosed with bipolar disorder. Adolescent cannabis use was associated with bipolar disorder (hazard ratio [HR] =3.46; 95% confidence interval [CI] 1.81-6.61). This association remained statistically significant after adjusting for sex, family structure, and parental psychiatric disorders (HR =3.00; 95% CI 1.47-6.13) and after further adjusting for adolescent emotional and behavioral problems (HR =2.34; 95% CI 1.11-4.94). Further adjustments for frequent alcohol intoxications, daily smoking and lifetime illicit drug use attenuated the associations to statistically non-significant.

CONCLUSIONS: In Finland, the positive association between early cannabis exposure and subsequent development of bipolar disorder appears to be confounded by other substance use.

PMID:35315149 | DOI:10.1111/add.15881